Cityblock Health, a New York-based digital health unicorn focused on primary care for Medicaid and underserved populations, has named Dr. Toyin Ajayi as its new CEO.

Ajayi takes over from her fellow Cityblock co-founder, Iyah Romm, who stepped away from the top spot at the startup in November to take a leave of absence for mental health. In Romm’s place, Cityblock was led by an office of the CEO, composed of Andy Slavitt, Cityblock’s board chair and former administrator of the Centers for Medicaid and Medicare Services, Ajayi and other members of the executive leadership team.

Before founding Cityblock with Romm and Bay Gross, the company’s chief technical officer, Ajayi was the chief medical officer of Commonwealth Care Alliance, a not-for-profit, integrated health system in Boston. Romm will remain on Cityblock’s board of directors.

Cityblock has raised approximately $891 million in venture capital funds in five years and is valued at more than $1 billion. With a mix of in-person and virtual care for membership-based care, the company has expanded into new markets in the Northeast, North Carolina and, later this year, Ohio.

Digital Health Business & Technology spoke with Ajayi about her goals as CEO, standing out among a crowded field in primary care disruption and more. This interview has been edited for length and clarity.

Congrats on the new job; why was this the right time for Cityblock to undergo this change in leadership?

Iyah has spoken very publicly about his reasons for taking a leave of absence and I’ll let him speak for himself on that. When it became clear he was ready to permanently transition out of the role, we, as a company, and the board, in their obligation, started to evaluate and assess potential next steps. They asked me to consider taking the role and here we are.

As the new CEO, what are your goals, both short and long term?

The next chapter of this journey for us is to consolidate and scale our model and take advantage of the opportunity ahead of us. There are no big pivots that I’m here to announce or anything like that. We recognize that there continues to be a huge opportunity to have an outsized impact on the lives and wellbeing of those who need it the most. Serving Medicaid and dual-eligible populations is a really challenging business problem that many health plans have found almost intractable over the years.

As you said, reaching these populations has never been easy for the healthcare system. How has Cityblock scaled up? 

We build longitudinal trusted relationships with our patients. We start by looking at the real experience of lots of people on Medicaid with complex healthcare needs. They often have experiences from the healthcare system that are not affirming or dignifying, or that make them feel alienated, like they are not really being listened to. And they have so many competing needs in their day to day that going to see a primary care doctor can be a real challenge, especially if you have to find resources to pay for transportation to get there, cover childcare or take off from work. There are real tradeoffs in the way that traditional healthcare is not accessible to the members we serve that cause a lack of engagement and participation in primary care, behavioral health and social services.

What we try to do differently is find and engage people to build trusted relationships with them. It’s about understanding what matters and being able to deliver integrated care to individuals, to really meet them where they are. Our teams deliver primary care, behavioral health, substance use disorder treatment, social services, coordination and care management services to our members 24/7 in their homes, at our physical brick-and-mortar hubs and virtually. It’s not rocket science, but it’s certainly eluded the healthcare system for a long time in many ways. And it’s hard. And it’s important for us to really deliver against those key capabilities to see the outcomes that we need.

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Digital health is a big component of how Cityblock has engaged with members. Without the forcing function of the pandemic, how do you maintain the momentum of wider telehealth and digital health adoption to keep members engaged?

Remember, for us it’s not just about telehealth. Technology encompasses the way that we use data to gather insights on our members, predict outcomes and intervene more effectively. It’s also how we measure our performance and keep our care teams accountable to outcomes. There are a whole host of use cases for technology—beyond telehealth—in building and scaling a business like ours.

On the telehealth side, we recognize just how important asynchronous virtual care can be. We were listening to our members and what we found is that, while smartphones are ubiquitous in this population, data access is not. Anything that requires a very heavy data burden or someone to be tech savvy has been challenging for these populations. So, we focused on lower tech capabilities in the beginning. Texting is so useful and has been, until recently, very underutilized for Medicaid populations. That was a very early part of our approach to technology: figuring out ways to stay connected with our members with the tools that were appropriate (for) and comfortable to them.

As the pandemic started and got worse, we knew we needed to use technology to provide in-home care more effectively than we had been doing before. We developed an interesting approach to telehealth for our members where we facilitate a visit with a clinician using our EMTs and paramedics. We’re not just saying to somebody, ‘Go download an app, get online and talk to this doctor.’ We’re actually going to send somebody to a member’s home at their bedside, to make sure they are fully situated, help check their vital signs, examine them physically, get their labs and augment a full clinical visit—and then we make sure they’re connected in real time with a clinician. That has been really powerful for us in both providing primary care and urgent care for our members, who don’t want to—or don’t need to—go into the hospital.

How does Cityblock stand out among the many digital health-based primary care disruptors that have popped up?

A lot of the other primary care disruptors in this space are led by people who have a similar mission and values to us—people who are taking the hard path to solve something that has so long been left untouched, particularly those that are focusing on lower-income folks with complex needs. We’re all comrades in arms as we try to disrupt this healthcare system. We have built really great partnerships and friendships across these types of companies. It’s heartwarming and affirming to see more and more innovators enter this space. Ten years ago, they would be building top tech startups focused on the one percent, people who have resources and (are) commercially insured. But now these innovators are taking their skills and their talents towards solving problems for folks who have been so undervalued and underappreciated. There’s a lot of work to be done in this space and we’re excited about it. I’m excited to see others enter the space. I think there’s room for all of us. There’s a lot we can learn from each other. There’s a lot of room to collectively push for some of the policy and system changes that are also necessary to enable more value-based care.